美国母乳喂养与围产期后婴儿死亡：一项全国性前瞻性队列分析
Breastfeeding and post-perinatal infant deaths in the United States, A national prospective cohort analysis.
作者信息
Li Ruowei, Ware Julie, Chen Aimin, Nelson Jennifer M, Kmet Jennifer M, Parks Sharyn E, Morrow Ardythe L, Chen Jian, Perrine Cria G
机构信息
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Division of General and Community Pediatrics, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
出版信息
Lancet Reg Health Am. 2022 Jan;5. doi: 10.1016/j.lana.2021.100094.
BACKGROUND
Reducing infant mortality is a major public health goal. The potential impact of breastfeeding on infant deaths is not well studied in the United States (US).
METHODS
We analyzed linked birth-death certificates for 3,230,500 US births that occurred in 2017, including 6,969 post-perinatal deaths from 7-364 days of age as the primary outcome, further specified as late-neonatal (7-27 days) or post-neonatal (28-364 days) deaths. The primary exposure was 'ever breastfed' obtained from birth certificates. Multiple logistic regression examined associations of ever breastfeeding with post-perinatal deaths and specific causes of deaths, controlling for maternal and infant factors.
FINDINGS
We observed an adjusted reduced odds ratio (AOR)= 0·74 with 95% confidence intervals (CI)=0·70-0·79 for the association of breastfeeding initiation with overall infant deaths (7-364 days), AOR=0·60 (0·54-0·67) for late-neonatal deaths, and AOR=0·81 (0·76-0·87) for post-neonatal deaths. In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55-0·74)], non-Hispanic Whites [AOR=0·75 (0·69-0·81)], non-Hispanic Blacks [AOR=0·83 (0·75-0·91)], and non-Hispanic Asians [AOR=0·51 (0·36-0·72)]. Across racial/ethnic groups, effect sizes for late-neonatal deaths were consistently larger than those for post-neonatal deaths. Significant effects of breastfeeding initiation were observed for deaths due to infection [AOR=0·81(0·69-0·94)], Sudden Unexpected Infant Death [AOR=0·85 (0·78-0·92)], and necrotizing enterocolitis [AOR=0·67 (0·49-0·90)].
INTERPRETATION
Breastfeeding initiation is significantly associated with reduced odds of post-perinatal infant deaths in multiple racial and ethnic groups within the US population. These findings support efforts to improve breastfeeding in infant mortality reduction initiatives.
背景
降低婴儿死亡率是一项主要的公共卫生目标。母乳喂养对婴儿死亡的潜在影响在美国尚未得到充分研究。
方法
我们分析了2017年美国3230500例出生的关联出生-死亡证明，将7至364日龄的6969例围产期后死亡作为主要结局，进一步细分为晚期新生儿（7至27日龄）或新生儿后期（28至364日龄）死亡。主要暴露因素是从出生证明中获取的“曾经母乳喂养”。多因素logistic回归分析了曾经母乳喂养与围产期后死亡及特定死因之间的关联，并对母婴因素进行了控制。
结果
我们观察到，母乳喂养开始与总体婴儿死亡（7至364日龄）之间的关联调整后比值比（AOR）=0.74，95%置信区间（CI）=0.70 - 0.79；晚期新生儿死亡的AOR = 0.60（0.54 - 0.67）；新生儿后期死亡的AOR = 0.81（0.76 - 0.87）。在按种族/族裔分层的分析中，观察到母乳喂养开始与总体婴儿死亡几率降低之间存在显著关联，西班牙裔[AOR = 0.64（0.55 - 0.74）]、非西班牙裔白人[AOR = 0.75（0.69 - 0.81）]、非西班牙裔黑人[AOR = 0.83（0.75 - 0.91）]和非西班牙裔亚洲人[AOR = 0.51（0.36 - 0.72）]。在所有种族/族裔群体中，晚期新生儿死亡的效应量始终大于新生儿后期死亡的效应量。母乳喂养开始对因感染导致的死亡[AOR = 0.81（0.69 - 0.94）]、婴儿不明原因猝死[AOR = 0.85（0.78 - 0.92）]和坏死性小肠结肠炎[AOR = 0.67（0.49 - 0.90）]有显著影响。
解读
母乳喂养开始与美国人群中多个种族和族裔群体围产期后婴儿死亡几率降低显著相关。这些发现支持在降低婴儿死亡率的举措中努力促进母乳喂养。
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